TITLE:
Outcomes in Seriously Head-Injured Patients Undergoing Pre-Hospital Tracheal Intubation vs. Emergency Department Tracheal Intubation
AUTHORS:
John M. Tallon, Gordon Flowerdew, Ronald D. Stewart, George Kovacs
KEYWORDS:
Trauma; Head Injury; Tracheal Intubation; Mortality; Emergency Medical Services; Emergency Medicine
JOURNAL NAME:
International Journal of Clinical Medicine,
Vol.4 No.2,
February
26,
2013
ABSTRACT: Background: The optimal treatment of major
head injuries in the resuscitative phase of care post-injury has yet to be
determined. This study measured the effect on mortality of pre-hospital
intubation (PHI) vs. emergency department in tubation
(EDI) of patients suffering serious head injury. Methods: In the single emergency
medical services system for this Canadian province, we used a population-based
trauma database, conventional logistic regression (with and without the use of
a propensity score to control for selection effect bias) to evaluate the effect
of PHI vs. EDI on in-hospital mortality. Inclusion criteria were age ≥ 16 years, serious head injury (Abbreviated Injury Score
≥ 3, non-penetrating trauma) and resuscitative intubation
(PHI or EDI). Results: Over 5 years, 283 patients
(2000-2005) met inclusion crite ria.
Conventional unconditional logistic regression modelled on mortality with “PHI
vs. EDI” as the intervention of interest showed an odds ratio of 2.015 (95% CI 1.062 3.825) for improved survival if these patients were
intubated in the emergency department rather than in the pre-hospital phase of
care. A propensity score adjustment demonstrated a similar but more
conservative point estimate (OR 1.727, 95% CI: 0.993 3.004). Conclusions: This observational study
demonstrated a survival advantage with EDI (versus PHI) in seriously
head-injured patients in a mature, province-wide emergency medical services
system.